The Parallel Realities of Gender: Two gender conferences in the same town present starkly different realities.
Killarney, a charming town of 14,000 in southwest Ireland, tucked in the shadows of the McGillycuddy Reeks mountains, is hardly the bustling center of Europe—or of gender medicine for that matter. But this past April, it served as the setting for not one but two conferences on the subject.
The European Professional Association for Transgender Health, or EPATH, held its fifth conference there, titled “Strengthening the standards: communities and research.” Some 500 attendees, from psychologists to surgeons to sociologists, gathered in the local convention center to showcase research ranging from “Acoustic long-term effects of a speech feminization protocol for transgender women” to “Being a trans* person during a pandemic.”
Some 1.8 miles down the road in downtown Killarney, another group had assembled. Genspect, a non-partisan organization “devoted to advancing a healthy approach to sex and gender,” was holding a conference of its own, intended as a counter to EPATH’s, which, Genspect alleged, “brooks no debate and incorrectly insists that the ‘science is settled.’” Genspect’s “Bigger Picture” conference would challenge evidence and showcase damage wrought by the gender-affirmative approach, offering “the human stories beyond medical transition.”
I’d ventured there from New York City because, five years earlier, when I first started researching gender issues, I’d gone to two gender conferences in California’s Bay Area. One was an academic conference, during which child development experts presented data showing the many complexities of how young people learn about and experience gender. The other was a conference put on by an advocacy group for transgender children and their families. There I saw that same research misinterpreted to present a singular narrative about the innateness of gender identity—which hadn’t been supported by the data.
I wondered if the same thing would happen in Killarney.
Gender clinicians in much of Europe have been under a microscope as of late. With new, strict guidelines for youth gender medical transition in Finland and Sweden, the impending closing of England’s Gender Identity Development Service, and the publication of Hannah Barnes’ book TIME TO THINK, detailing the problems there, more people are becoming aware of the controversies in pediatric and adolescent gender care.
Those problems include: the population of adolescents seeking “sex changes” has increased exponentially in much of the Western world, and has almost completely shifted from the original population. Instead of teen boys with lifelong gender dysphoria and few other mental health problems, now it is mostly teen girls with no history of gender distress until adolescence, many of whom have coexisting mental health issues like eating disorders or bipolar disorder. Many families feel pressured and rushed to facilitate transition, told sometimes by clinicians that their child will commit suicide if they don’t.
But systematic evidence reviews have shown that the quality of research on the efficacy of medical transition is so low that it can’t be trusted. And, meanwhile, the number of detransitioners—those who medically transitioned and regretted it—is growing. When EPATH’s parent group, the World Professional Association for Transgender health, released the 8th version of its Standards of Care earlier this year, there was international outcry at the removal of any age minimums for puberty blockers, cross-sex hormones, or even genital surgeries, and the inclusion of a chapter on eunuch gender identity—while the chapter on ethics had been removed, and one on detransitioners had never been considered.
For years, the most common talking point from many practitioners and defenders of gender-affirming care has been “no debate.” They automatically dismissed any questioning of gender-affirming care or the policies around it as hateful and bigoted. But at the opening plenary, outgoing EPATH president Joz Motmans assured attendees in his welcoming remarks that “True scientific development needs debate and constructive criticism to develop.” Thus, they value “nuance, dialectic, scientific debate.”
And indeed, to my pleasant surprise, several presentations did acknowledge the criticisms leveled at EPATH and its adherents. Doctors acknowledged the flip in the sex ratio and ages of those seeking to transition; the existence of detransitioners; and the low-quality of evidence to support interventions for adolescents.
But these concerns were mostly raised in order to explain them away. Lots of treatments have low-quality research, they said, and more teen girls are coming out than other groups because of greater social acceptance of transgender people today. The rest of Motmans’ speech painted their profession as under siege, and dictated the boundaries of appropriate speech. “We all are, in some way or another, experiencing pressure or straightforward attacks,” he said. “We witness a rise of anti-gender and anti-trans voices, legislation, policies, and movements.” He painted the backlash as part of the general “anti-woke” movement against immigration and vaccination, with far right groups jockeying for political clout. He compared critics of gender-affirming care to flat-earthers and climate change deniers.
“We respect everyone’s freedom of speech,” he said, adding, chillingly: “But we will not listen to it.”
I took this to mean that EPATH attendees were allowed to ask questions—just not the wrong kind. The powers that be seemed unable to distinguish between the criticism of their approach to gender affirming healthcare and criticism of them as people.
And so, for the most part, people didn’t ask questions. When one Swedish study showed a sharp increase in mental well-being after puberty blockers or hormones, followed by a steady, steep decline over two years, no one raised a hand and asked why the kids had gotten worse. When a presentation about a 17-year follow-up of transitioned adolescents with autism revealed that two of 30 had committed suicide, nobody asked: How much do you think the suicide risk is related to autism, and how much to gender identity? Two out of thirty had detransitioned, but no one asked about that, either. No matter what the data actually said, gender-affirming care was necessary, evidence-based and life-saving. I got the sense that each person was supposed to repeat this until they believed it.
Still, attendees seemed jazzed to be there, upbeat and optimistic between the declarations that anti-trans hate, rather than evidence-based dissent, was endangering them. The writer Eliza Mondegreen, with whom I was skulking about, called the atmosphere “a family holiday after something has gone badly wrong, where nothing that needs to be said will be said.”
During day 2 of the EPATH conference, in a hotel and spa with shiny brass handrails and a bustling restaurant, Genspect’s The Bigger Picture convened. The atmosphere was quite different: somehow both jovial and irate. This was a gathering of mainly gender-critical folks, who often respect trans people’s civil rights but reject the notion of gender identity and believe that biological sex is paramount in medicine, law and other societal arenas. Many felt unable to express their views in public, for fear of losing friends, jobs, or even their relationships with their children. Indeed, one of the opening speakers was Maya Forstater, who’d lost her job for her gender-critical beliefs, and had only recently won the court case she’d brought as a result.
Genspect had invited anyone with an EPATH badge to attend their conference, and had actively reached out to journalists—quite the opposite of EPATH, which had banned journalists because they didn’t like the way they’d been portrayed last time journalists had been allowed access. In fact, I did see a few people from EPATH in the audience, including a trans woman who’d transitioned as a child, from puberty blockers straight to cross-sex hormones. She told me she was probably more partial to EPATH’s perspective, but she was curious. I also met a Dutch plastic surgeon who’d come because she was concerned about what she called “sudden onset” cases, and wanted to learn from detransitioners. “Nobody wants that outcome,” she said.
I felt enormously hopeful at this. Sure, only a few EPATH folks had ventured over, but they were open to learning! Ever since the researcher Lisa Littman coined the term Rapid Onset Gender Dysphoria in 2016 to describe the emerging cohort of teen girls coming out suddenly and in clusters, the research has been hopelessly, unhelpfully politicized. Many trans activists, researchers, and clinicians swooped in to explain that these girls were simply benefitting from the newfound acceptance of trans youth, and that we should not be concerned that they were experiencing a form of social contagion. Now they could see the eminently reasonable Littman herself, a woman whose presence conveys zero percent hate and who is open to critiques and complexities.
Still, I was worried that Genspect wasn’t welcoming enough to the believers in gender-affirming care who’d wandered down the road. Genspect vice-director Alisdair Gunn’s pronoun joke—“My pronouns are your bank account number, your mother's maiden name, and the name of your first pet”—made me laugh, but I also wondered if it would alienate the curious clinicians. When the audience cheered for single-sex bathrooms, I worried those who’d come with an open mind would feel the need to close it as a form of self-protection.
But I was quickly set at ease, especially when Gunn encouraged attendees to dissent. “We welcome robust debate,” he said. “We believe in lots of different points of view.” No caveats, no warnings. Genspect’s conference was indeed full of respectful disagreement, and there were often too many questions to get to.
If the true free speech atmosphere set me at ease—I was welcome there, and so were my questions—I was deeply discomfited by what I took in, and especially how it related to what I’d seen at EPATH. Both Eliza Mondegreen and Stephanie Davies-Arai of Transgender Trend offered astounding presentations on cultural and online influences of trans-identified kids. No one, I thought, should administer hormones or cut off body parts before asking: Where did you get the idea that this will improve your life? How many books with popular kids with mastectomy scars have you read? How often have you scoured Reddit, being assured that any doubt you feel is proof that you’re really trans?
At EPATH, there’d been a session on “Childhood gender nonconformity in relation to gender dysphoria and psychiatric outcomes,” which noted the established connection between childhood gender nonconformity and gender dysphoria. “However,” the abstract noted, “the majority of children with gender nonconforming behavior are not diagnosed with gender dysphoria in adolescence or adulthood, and more evidence on the link between gender nonconformity and gender dysphoria is required.”
They seemed to almost be fishing for clients, wondering why more gender nonconforming kids weren’t dysphoric, instead of accepting gender nonconformity as a normal variation of human existence. But at Genspect’s conference, sociologist Michael Biggs’ presentation established the difference between age-old cross-gendered behavior in children and the very new concept of the transgender child—with a condition that must be treated, as opposed to accepted. Then psychologist Kenneth Zucker presented the “desistance literature,” 11 high-quality prospective studies that show a very high rate of desistance when gender dysphoric children are not socially transitioned; the majority of those kids grow up to be same-sex attracted. The association found in the research is between gender nonconformity and homosexuality, more than gender dysphoria.
At EPATH, one long presentation acknowledged the low-quality of evidence to support puberty blockers, cross-sex hormones and surgeries for young people with gender dysphoria. But at Genspect, Dr. Julia Mason went into detail about what that actually meant. One anonymous retrospective survey of adults who still identify as transgender (used erroneously to assert a low detransition rate) showed adults who wanted and got puberty blockers had better mental health than those who wanted them and didn’t get them. But many said they were over 18 when they took them, which means they probably didn’t understand what puberty blockers were. And many were denied medical interventions if their mental health was already bad; it doesn’t mean not getting the drugs made them worse, but that they weren’t well enough to take them.
That EPATH paper, which showed a spike in mental health directly after puberty blockers or hormones, followed by a serious plummet, was nothing but an abstract graph at the clinicians’ conference. But at Genspect’s The Bigger Picture, the numbers, the figures, came to life during a panel of detransitioners. Some had been gay, and not realized that gender dysphoria and homosexuality sometimes overlap. Some had been depressed, autistic, lonely, awkward, gender nonconforming, convinced that transition would save their lives, and certain that the doctors diagnosing them with gender dysphoria and removing their breasts or penises knew what they were doing. They hadn’t had the benefit of informed consent. Rather, they’d been misinformed. Why, said a panelist named Camille, had doctors removed her healthy breasts instead of investigating her childhood trauma?
One panelist, Ritchie, wasn’t sure that “detransition” was a useful term anymore. “I think I’m in recovery,” he said. Indeed, one person compared transition to the Eagles’ song Hotel California—you can check out anytime you like, but you can never leave. They’d each be dealing with the repercussions of their treatments for the rest of their lives.
Yes, there had a been single poster presentation on detransition at EPATH, out of nearly 250 offerings, but those academics hadn’t had the human manifestation of bad medicine standing before them, challenging them to understand what happens when the gender-affirming model goes wrong.
During Genspect’s presentations, it became crystal clear to me that in the five years that I’ve been researching this topic, the sex ratios weren’t the only thing that had flipped. Now, the academic conference was misrepresenting information and distorting research, and the conference put on by an advocacy group was telling the complex, heavily researched truth. The conferences took place in parallel universes, but EPATH’s was divorced from reality. Genspect’s was mired in it, a gathering of the angry, the traumatized, the gaslit, the silenced—and, increasingly, the hopeful. Things are beginning to change.
In the end, I felt I must change, too. Though I don’t usually publicly opine about whether or not it’s okay for children to medically transition, I left there thinking that the careful tack I’ve chosen was part of the problem. There are too many people getting hurt to ignore them anymore, to gently prod those in denial to open their eyes. There are too many risks to only focus on benefits. Gender clinicians cannot live in their own subjective reality anymore. They must cross the street, and listen to the other side.
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